PAE or UroLift after prior radiation for prostate cancer

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Has anyone had, or does anyone know of anyone who has had either PAE or UroLift AFTER haveing had prior radiation to the prostate for Gleason 6 prostate cancer?

I had HDR Brachytherapy radiation in Sept. 2014. Prior to that I had BPH issues for four years, and since the HDR still have all of the typical BPH symptoms. My prostate was meaured at 56cc two years ago with some median lobe extension. Normally, after radiation, the prostate stops growing and actually shrinks a bit, and it feels like this has happened in my case.

But the BPH symptoms persist and I was turned down for PAE last year because of the prior radiation, and just spoke with a urologist who was unsure about the UroLift on the same grounds - that the prostate is no longer pliable. 

Any ideas would be very much appreciated.

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  • Posted

    It is my understanding that there are very few options after radiation therapy and most require a specialist and results are mixed. However, I recently read that HIFU can be used even after radiation. HIFU has been used to treat cancer for a little over 12 years now and was originally to treat bph. Lookup and call Dr. Suarez he is one of the original doctors who introduced it in the US. If your not in the US, I can get you a referral, just let me know where you are located.
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  • Posted

    I am also interested in this, but in opposite way, to have PAE first, if qualified and still have Brachytherapyoption available when or if required to deal with Gl 6 cancer, if I choose to, but high dose of radiation from PAE procedure may preclude any additional amount of radiation from Brachy ? this might be why you were  turned down for PAE last year because of the prior HDR radiation
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    • Posted

      I don't think they will do PAE if you have been diagnosed with cancer as there is concern that reducing oxygen (blood flow) may cause a non aggressive cancer to become aggressive. If you do not have cancer, then PAE or Urolift might be a great way to go. (Although there have been some recent posts on this forum from guys who said their erections are not as strong after PAE). If you have cancer, then checkout HIFU. Also, there is a Dr. Gat in Israel that is doing a procedure similar to PAE but I don't know if he does it once you are diagnosed with cancer.
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    • Posted

      The concern with the PAE was that after radiation the prostate has some scar tissue, and the doctors were not sure if the PAE would cause some complications. They were not concerned with additional radiation. I assume you are referring to the imaging that takes place during the PAE procedure. 
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    • Posted

      I have already been treated for the cancer. As for HIFU for cancer, it is only a focal treatment, meaning that it is for cancer that is localized in one area of the prostate. HIFU only treats part of the gland. 
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    • Posted

      We are having two different conversations with two different scenarios. Tom, you are seeking treatment for bph AFTER radiation and my answer to you is your options after radiation are limited but HIFU is probably still an option for you as HIFU has been used to treat bph. I was not suggesting HIFU for you to treat cancer. Your question was what options are available after radiation and I gave you one. There might be other options, I just told you what option I knew could possibly work for you if PAE or Urolift are off the table.

      You are right that HIFU is for localized prostate cancer but you are incorrect about only treating one area. It can be used to treat more than one area. I know this because that is the option I have been given for when I schedule my procedure.

      The other conversation is with Andrze and a totally different scenario in which (if I understand correctly) he wants to have a treatment for bph and then treat the cancer of Gleason 6. I don't know about Urolift and if they would do that procedure first and then treat the cancer (although I don't know why they wouldn't as it does not restrict the blood flow and therefore would not potentially make the cancer become aggressive) so that sound viable. I just know from experience that they will not do PAE on someone who has been diagnosed with prostate cancer. I only suggested Andrze look into HIFU to treat the cancer because first, there is NO radiation involved (and some studies have shown any type of radiation therapy has the potential to cause INCONTINENCE and ED issues after 5 to 10 years plus rectal bleeding. These issues do not occur right away, it is down the road...but the radiation eventually catches up with you, it progressively gets worse and there is NO reversing it. (And that hold true for brachytherapy too).

      So, my suggestion for treating cancer was to Andrze. And my suggestion for treating bph (after radiation was for you.

      I hope that helps and clarifies how HIFU might help either one or both of you.

      Best of luck in your search for the right solution for your situation.

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    • Posted

      ES,

      Thank you for the good response. Just to clarify one point I made about HIFU. I was not suggesting that HIFU can only treat one area, but it is not meant as a whole gland treatment because it would take too much time for that, so, based on my research, it only treats part of the prostate and is not meant for someone with prostate in many areas. 

      About radiation for prostate cancer. There are basically two types of procedures. The first (external beam) shoots photons through your tissues and into the prostate. The second type distributes the radiation to specific areas from within (Brachytherapy) or external (proton beam) but that beam is only active over a short distance (Bragg Peak) so it has minimal effect or other tissues. Both Brachytherapy (in particular HDR - high dose rate) and proton beam have extremely good percentage cures for the cancer and also minimal effects on other tissues. Every attempt is made through imaging to avoid damaging the nerves that cause erections (nerve sparing Brachytherapy) and the imaging that's done during the operation is absolutely amazing. I went on a tour of the Brachytherapy facility and was given a demonstration of the imaging - it's like Star Trek. 

      Anyway, the odds of having ED and incotinence with prostate removal (radical prostatectomy) are MUCH higher than with proton bean or HDR Brachytherapy. So, when deciding on treatment you want the highest chance of killing the cancer with the least side effects. 

      I had my treatment in Sept of 2014 and have had no issues with ED, incontinence or any rectal issues - none. 

      Radiation has traditionally been done for men who are older and aren't candidates for prostate removal, so it makes sense that some years later they would get ED or continence issues. 

      Because there are so many possible treatments for prostate cancer AND also different treatments for BPH, it becomes an almost overwhelming maze of reading research, interviewing physicians, an going on forums - it can almost take over your life trying to figure out what to do.

      I am now leaning more toward the UroLift if it will work for me because there is no cutting, no laser, no steam, no microwave, no catheters - it's just quick and quite effective, and reversable. 

      Anyway, I am the type of person who researches extensively until I believe I can make the best decision. That's why I appreciate this forum so much.

      Anyway, back to my original question, I still can't find anyone who has had either PAE or UroLift after radiation for prostate cancer - it all appears to be speculative.

      Tom

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    • Posted

      Hi Tom,

      I think we are a lot alike both in our prostate issues and the amount of research we do on any given topic. You almost had me laughing because you were describing me in your frustration on how much time/research a person can put into this topic. You are very well informed and certainly are caring in the way you present your facts to others. It sounds like you have taken care of your cancer and now need to address the urinary issues due to a large prostate. I'm glad to hear you are a candidate for PAE and wish you luck with that procedure. Please keep us informed as to your progress. As for me, I'm starting a high dose of Avodart today. (Actually a little worried about side effects because of the very high dosage). But if it works, then on to HIFU.

      Keep researching, posting and helping people. It's great to have people like you on this forum.

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    • Posted

      "Although there have been some recent posts on this forum from guys who said their erections are not as strong after PAE"

      Where did you read this?

      Thanks

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  • Posted

    ES & Tom

    just received an answer from Dr.Pisco, had him review my info if I am a candidate for PAE, (I am Gleason 6, with 10% one core involvement only), he confirmed I am a good candidate for PAE procedure. I will follow up with him specifically questioning him about this issue,  "that reducing oxygen (blood flow) may cause a non-aggressive cancer to become aggressive".

    Tom, you mentioned your experience

    The other question I will ask, is high dose of radiation from fluoroscopic procedure during angiography poses a potential for increasing the patient's risk of radiation-induced cancer. Will this high dose of radiation preclude me from any other future radiation procedure that I may need or consider?

    Will get back here with his answers.

    Tom, you said " I just know from experience that they will not do PAE on someone who has been diagnosed with prostate cancer" can you elaborate from where this info comes?

    Thanks

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    • Posted

      Andrze I was the one who made the statement regarding concern about PAE causing cancer to become aggressive. There are some studies on it (that someone on this forum sent me) but I can not find it at the moment.

      I was speaking from personal experience because I had set an appointment with Dr.Isaacson at Florida and Duke Medical. He comes highly recommended for the PAE procedure. However, after I was diagnosed with Gleason 6 cancer he said he would not do the PAE on me because of the concern that the restriction of oxygen may cause the cancer to become aggressive. So that's how I know firsthand. Perhaps other Doctors are willing to still do the treatment. I was not willing to risk it.

      I would guess that if you have the PAE and then very very soon afterwards do a treatment to kill the cancer then the PAE might still be an option for you.

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    • Posted

      Andrezej,

      Just to clarify: late last year I was turned down for PAE because I had radiation for prostate cancer (HDR Brachytherapy) 14 months before. This was NOT because of the radiation but because they said that once a prostate has been radiated it has scar tissue and they weren't sure what would happen if they cut off blood flow to some of the artieries. However, I just spoke with the head of the Interventional Radiology department at the same hospital and he said he would do it. That might make me the first and only person anywhere to have PAE done to a radiated prostate. The additional radiation from the imaging was not discussed as it is a very low dose. 

      To clarify again - they were reluctant to do the PAE because I had prior radiation to the prostate, NOT because I had a prior diagnosis. That is a different issue. 

      Also, if you are Gleason 6 with only 10% of one core involved you are in the very low risk category and probably should be on active surveillance and you may never need treatment. If you are really concerned, you should also consider getting a genetic test on the prostate tissue (Oncytype DX from Genomic Health) to see if the cancer is passive or agressive. It is possible you might not need to be treated for a very long time, if ever, depending on your age and physical condition. 

      The BIG ISSUE today in the field of prostate cancer is that small cancers are being found by improved imaging that might never need treatment. Also, there is a movement in the urology community to change the name of Gleason 6 from cancer to something else. Many feel it will never metasticize and should not be a concern. 

      I had Gleason 6 but 5 cores and over 50% in some cores after the second biopsy, so there was "progression" and I decided on treatment primarily for psychological reasons - easier to be treated than to keep getting biiopsies and worrying about it. 

      If you are concerned about the minor radiation from the PAE then you should seek some other treatment for your BPH symptoms first.

      Tom

       

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    • Posted

      I was wondering if you found the report you mentioned. I had a very sucessful PAE with Dr Bagla in Virginia. He asserted very strongly that PAE does not have that effect. I'd be interested because I might do more agressive monitoring (3T mri poerhaps). Thanks

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